Metastatic Tumors



Metastatic Tumors






Epidemiology

Eight times more common than primary brain tumors. 25% of all patients with systemic cancer have intracranial metastases (15% brain, 5% meninges, 5% dura; Table 62.1).


Brain Metastasis

50% of patients have single lesion, 20% have only 2 lesions.


Clinical Features

Usually subacute symptom onset (weeks): headache (25%), hemiparesis (25%), cognitive or behavioral change (15%),
seizures (15%). Acute symptom onset may occur with intratumor hemorrhage (melanoma, thyroid, renal cell, choriocarcinoma).








Table 62.1 Primary Tumors Commonly Associated with CNS Metastasis

























Parenchyma Lung, melanoma, breast, renal, gastrointestinal
Meninges  
  Dura, subdural Breast, prostate, melanoma, leukemia, neuroblastoma, lymphoma
  Leptomeninges Leukemia (especially ALL), lymphoma, carcinoma (breast, lung, melanoma)
Perineural (cranial nerves) Squamous cell carcinoma, basal cell carcinoma, carcinoma of minor salivary glands
Calvarium, skull base Breast, lung, prostate carcinoma
Spine Breast, prostate, lung carcinoma
ALL, acute lymphocytic leukemia.



  • Brain imaging: MRI shows contrast-enhancing lesions: typically spherical, at gray-white matter junction, with significant surrounding edema. Large lesions may show ring enhancement (due to central necrosis).

In patient with suspected brain metastases and unknown primary tumor: assess with thorough physical examination (breast, prostate, testicular, rectal lesions); check stool for occult blood; image with either CT of chest, abdomen and pelvis or total body PET scan with fluorodeoxyglucose to try to locate primary site.



  • Differential diagnosis: brain abscess, multifocal gliomas, demyelinating disease (occasionally large enhancing lesions), delayed radiation necrosis, stroke.

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Jul 27, 2016 | Posted by in NEUROLOGY | Comments Off on Metastatic Tumors

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